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Changes to State Subsidized Medical Care for ChildrenJuly 2, 2003Doug: Annette Hensley is a mother of three. Two of her children are now adults. Her youngest, Trevor, is an active kid.Annette Hensley “He’s 13. He’s a skateboarder, so he gets hurt quite often (chuckles).” Doug: Years ago, Hensley enrolled her children in one of the Washington state-run Medicaid programs. The others are too old to be eligible now, but Trevor is still covered, and Hensley says it’s a good thing he is. Hensley “He just cracked his ribs not long ago and I had to take him in. And if I would have had to pay for that, it would have been impossible to do.” Doug: For years, Hensley has not had to pay for her children’s medical care, no premiums, no co-payments. But, beginning next year, that will change. The Washington Department of Social and Health Services, with the assent of the legislature, is planning to require many Medicaid families to pay part of the cost of their insurance. Washington first needs the federal government’s permission, but considering almost half of the states now charge Medicaid premiums, that probably won’t be a problem. The change to requiring premiums, says Doug Porter, the state’s Medicaid director, is purely financial. Doug Porter “The Medicaid program is being asked to find every way possible to reduce its increase in growth.” Doug: With more people losing either their jobs or their health benefits, more are turning to the state for insurance. But at a time of a sluggish state economy, Porter says the state can’t afford it. So he says the state is trying to route its limited health care dollars to the people who need it the most and to services that offer the most help. It will less spend less for dental coverage for adults. It will begin charging adults a few dollars for eye appointments and glasses and for things like wheelchairs and crutches. And it will require that parents pay each month to keep their children enrolled in Medicaid programs. The poorest families, those who make less than the federal poverty level, will still qualify for free care, but as their incomes increase, Porter says parents will pay premiums of 15-to-25 dollars per child per month, up to three children. Porter “It’s less than two-and-a-half percent of their income, so it’s half of what the federal government has called out as a maximum. We recognize that anywhere from 10-to-15-percent of the children currently covered may drop coverage because of the premium. My hope is that they don’t, and I further hope that, even if they do, that when they need the service, they’ll come back and pay the premium to get adequate health coverage.” Doug: Advocacy groups are skeptical. Linda Stone from the Children’s Alliance says the premiums parents pay will make up only a small amount of the money the state wants to save. She says the more lucrative strategy is to make even subsidized health care too expensive for poor families. Linda Stone “The assumption that’s built into the state budget is that 20-thousand kids will lose health insurance coverage because their parents are unable to pay the premium. I mean, we think, based on other states’ experiences, it’s probably gonna be more like 60-thousand.” Doug: Stone acknowledges the state may save money in the short run. But one researcher says, in the long run, it may not save as much as it wants. Leighton Ku, a senior fellow at the Center on Budget and Policy Priorities, a Washington D-C think tank, cites his 1997 study that examined how requiring poor people to pay medical premiums affects their behavior. Leighton Ku “We know, by looking at that kind of research, is that, in many cases, and this makes sense, that the people who stay on the program are likely to have children that are a little sicker than those who leave the program. Now, on one hand, this is good. It means that the kids who most need the care are, in most cases, still gonna have it. On the other hand, it also means that the state was trying to save money. It’s not saving as much as it might have thought because, generally speaking, it was the less expensive kids who will leave the program and the more expensive kids will stay on.” Doug: Twenty-two states, according to the Children’s Alliance, now or will soon assess premiums for their Medicaid programs. Washington’s premiums will be the highest or near the highest in all income ranges, from those just above the federal poverty level, all the way to two-and-a-half times the poverty level, above which subsidized care is no longer available. Annette Hensley says she’s willing to pay a monthly premium for her 13-year-old son Trevor. But she worries others who aren’t as well off won’t make the same decision. Hensley “You know, some people, ten bucks will be just too much for ‘em, ‘cause they’re barely getting by now, you know, with their bills and so forth. And, and, if they don’t have any extra things they can cut out to pay that, like, you know, I can cut out the internet or the extra phone line or whatever, so that I can pay that. But some people just don’t have that option.” Doug: There’s one other provision that worries childrens’ advocacy groups. The Department of Social and Health Services proposes to change its income verification procedure. Until now, agency officials would ask Medicaid families once a year to provide proof of their income, to make sure that income was still low enough to qualify for subsidized care. Now they’ll ask twice a year and families will again be required to report changes to their income. On the surface, no big deal. Except that, until now, when a parent found a higher-paying job and moved to a new income level, the family could keep the subsidized care until it was time to verify its income again. Now, says Ralph DeCristoforo from the Health Improvement Partnership’s Health for All program, changes in income bring immediate results. Ralph DeCristoforo “So the child is basically on month-to-month coverage. So, you could very realistically have a child whose parent is either self-employed, or works on a commission that goes up and down each month. While it would average out each month, while it would average out in the long run, where they would be eligible if they used six-month or one-year worth of income, on a month-to-month basis, you would have a problem.” Doug: And, DeCristoforo says, children could be bounced from one coverage to another, or even to no coverage, right away. That’s confusing not only to families, he says, but also to doctors and nurses who aren’t sure whether their patient is covered while they’re seeing him or her. Karen Merrikan, the Director of Health Policy Development for Group Health, which administers Medicaid programs for children, says the new changes will be full of learning experiences for everyone involved. Karen Merrikan “I know that D-S-H-S and staff there are very, very focused and very concerned about maintaining continuity of care. But how you manage that under this kind of continual income eligibility, I think, remains to be seen.” Doug: Advocates for children believe the new changes will hurt plenty of kids in low-income families. Researcher Leighton Ku says parents will be forced to make tough financial decisions, and often, they’ll choose something other than medical care for their children. Ku “So maybe their child doesn’t get immunized or doesn’t get treatment for earaches and so this can have some negative repercussions. The thing that began as an earache turns into a ruptured ear membrane, so hearing could be compromised for life.” Doug: Ku says stories like this will be the exception, rather than the rule. But for the child who does have to suffer in circumstances like this, it is a big deal. For “Growing Up Healthy”, I’m Doug Nadvornick. By Doug Nadvornick 
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